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Photon, Perplexity, and Prior Auths
By Jason Barry
May 11, 2026
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Together with
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“If you look at a CMS demonstration model, they usually take five years of implementation and three years of analysis. You’re talking about eight years of rigorous study before you actually see what the true costs are on a population health level. Nothing has been scaled when it comes to AI at a system level to be able to definitively say, ‘Has this improved or worsened healthcare?’”
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CVS President of Health Care Delivery Sree Chaguturu
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Hope everyone saved room after their Mother’s Day feast because today’s newsletter has another tasty buffet of stories ready to go.
We’re serving up Photon’s $16M Series A, Perplexity’s healthcare push, Google’s new Health app, and a whole lot more.
Thanks for coming in!
Jason
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Electronic prescribing was designed to move prescriptions from point A to point B, not to give patients the information needed to pick those points on the spot. Photon just raised $16M in Series A funding to fill that gap.
Photon got its start in 2021 building prescription infrastructure for direct-to-consumer telehealth companies, powering some of the fastest-growing brands of the pandemic and GLP-1 era.
That experience provided a solid foundation. Photon built deep integrations across pharmacy networks, real-time formulary data, and a patient-first prescribing experience.
- That foundation not only proved compelling to DTC startups, but also to health systems looking for better ways to engage patients at the point of care and drive visibility into their in-house pharmacies.
- Fast forward to the Series A, and Photon is leaning in on the enterprise market where it can make the biggest impact.
Photon isn’t a pricing widget. It’s an end-to-end platform that includes:
- Modern prescribing and routing infrastructure
- A network of pharmacy partners across retail and home delivery
- A consumer-facing marketplace that surfaces real-time price and stock information
- A full suite of capabilities including prior auths and clinical decision support
AI underpins everything. Photon’s AI ingests fragmented data across pharmacy networks, benefit structures, and formularies, then translates it into info that patients can actually use.
- That gives patients a sense of what’s convenient, what’s covered, what delivery options are available, and most importantly – price.
- Put it all together, and patients can make informed choices before prescriptions ever get sent.
Health systems get something equally valuable. The prescription becomes a patient engagement touchpoint instead of a handoff.
- In-house pharmacy teams gain real-time visibility into fill activity, and having patients that are actually informed results in fewer abandoned scripts, less reroutes, and a meaningfully better experience for everyone involved.
The Takeaway
Right when healthcare services are getting disrupted by LLMs and agents, patients are hitting a boiling point with affordability and transparency. The pharmacy experience is a major intersection for both roads, and Photon just raised $16M to modernize all four corners.
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Abridge & Availity Redefine Payer-Provider Synergy
Abridge is teaming up with Availity to redefine payer-provider synergy at the point of conversation. The collaboration aligns Abridge’s evidence-aware intelligence with Availity’s real-time health information network to create a first-of-its-kind prior authorization experience, with a shared understanding between patients, providers, and payers. Find out how Abridge and Availity are extending conversational intelligence across the revenue cycle.
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DoxGPT Nabs a New Name – and Big Upgrades
The tool formerly known as DoxGPT is now called Ask, and it’s packing more upgrades than just the name. Ask’s new agentic reasoning model delivers better, faster answers to physician’s most complex clinical and workflow questions – with the same verified outputs, journal access, and drug dosing they already know and trust. Discover the difference and Ask today.
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- Perplexity Premium Health Sources: AI-powered search engine Perplexity took the lid off Premium Health Sources to help answer questions from consumers and clinicians alike. The new capability enables Perplexity to draw from medical journals and clinical guidelines, starting with a pair of big name partners: New England Journal of Medicine and BMJ Best Practice. Perplexity has some tough competition that’s spread less thin, but it sounds like it’s also planning to stake a bigger claim in the evidence landgrab with sources like Micromedex for medication information and Health Affairs for policy research.
- CMS Goes After Prior Auths: CMS is doubling down on its effort to modernize prior authorizations by adding electronic prior authorization to its Health Tech Ecosystem. The move arrives after last year’s “landmark pledge” to get payors to commit to easing the prior auth burden, and CMS designed the new initiative to “bring everyone else.” Health systems, hospitals, physician practices, EHR vendors, and digital health developers are now joining payors as “a unified coalition” to make electronic prior auths work end-to-end for every patient.
- Good News for Hospital-at-Home: A large study in JAMA Network Open provided the latest evidence that hospital-at-home can serve as a safe alternative to inpatient care. Among over 15k Medicare beneficiaries (4,174 HaH and 11,697 inpatient admissions), the analysis found that HaH admissions were associated with lower in-hospital mortality (0.4% vs. 3.6%) and lower ED use within 30 days of discharge (8.8% vs. 10.0%), with no significant difference in 30-day readmissions (11.7% vs. 11.0%). The authors concluded that HaH may maintain the same or better short term outcomes depending on “appropriately selected patients.”
- PitchBook’s Big AI Take: PitchBook put out a provocative report that stokes the flames of the AI-replacing-doctors discussion. “AI Will Deliver Care to Billions and Break the System That Built It” outlines a U.S. healthcare system reimagined by AI, with many of the generalist-specialist themes that other folks have been touching on, as well as how AI should be regulated and how care should get reimbursed. Pitchbook is in the camp that AI will increase costs in the short term by driving up demand for services, and that costs will only go down once new models tie reimbursement to outcomes.
- Unified Google Health App: Google unveiled its new Fitbit Air, and the announcement included the bigger news that the Fitbit app is getting overhauled into a Google Health app that serves as a centralized health platform that works across both Fitbits and Pixel Watches. Google said its Health app integrates with third-party apps and devices through Health Connect, Apple Health and Google Health APIs, allowing users to combine data from platforms like Peloton, MyFitnessPal, Dexcom and Abbott into a single dashboard.
- U.S. Menopause Differences: Withings published a great analysis of over 470k U.S. women that wrapped some interesting numbers around the menopause transition. The Menopause Transition 2026 Report leveraged data from Withings’ suite of connected devices to show that the prevalence of atrial fibrillation rises 3.8x in U.S. women, climbing from 1.86% in early reproductive years to 7.0% by late postmenopause. Heart rate variability during sleep – an increasingly popular marker of cardiovascular health – also declines just 17%, roughly half the 33% drop observed in women worldwide.
- A Typology of GenAI: A helpful paper in NEJM AI provided a fantastic termsheet for the many types of AI sweeping across the industry. The authors clarify key distinctions among emerging AI paradigms and provide a lens for understanding their functional differences, risks, and potential applications in clinical and administrative contexts. It maps out LLMs and chatbots like Claude and ChatGPT, AI platforms for everything from call centers to ambient scribes, as well as the new frontier of agentic AI systems. Worth the skim whether you’re looking for an initial overview of the space or just need a quick refresher.
- LLMs Tackle Prior Auth Denials: Researchers tested the ability of four large language models to dispute prior authorization denials for medical imaging scans in the DENIED-AI study in Academic Radiology. Four interventional radiologists gave the AI-generated appeal letters decent scores on a five-point scale for content (3.9) and grammar (4.3), but the prevalence of hallucinations led the authors to conclude that human oversight is still a necessity.
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Execution for Every Workflow
Health systems have no shortage of ideas for improving care and operations. Bunkerhill lets them bring those ideas to life – at scale, across service lines, and around the clock. Discover how the Carebricks platform is empowering clinical and operational teams to deploy AI agents that turn the data they have into the actions they need.
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The Virtual-First Difference at MetroHealth
When the MetroHealth System needed a comprehensive, scalable solution to help its patients access care, it turned to Ovatient’s virtual-first care model. Ovatient isn’t another point solution, it’s a virtual care partnership – integrated clinically, operationally, and technologically with your existing infrastructure. Discover how MetroHealth’s virtual-first approach is keeping patients connected to high-quality care whether they’re at home, at work, or on the go.
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Unlock Better Care With LOLA
Whether you’re looking to augment your team’s capacity or capabilities, Tucuvi’s clinically validated LOLA voice agent is purpose-built to make it happen – and has the success stories to prove it. Hear first-hand from Tucuvi’s customers how LOLA is empowering clinical teams to care for patients while maximizing ROI.
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- BPM Pro 2 Delivers Data When It’s Needed Most: BPM Pro 2’s built-in questionnaires capture patient context alongside each blood pressure reading, reducing manual outreach and follow-ups. See how BPM Pro 2 is equipping care teams with actionable information upfront, and helping streamline workflows and prioritize interventions where it’s needed most.
- 8 Keys to Gain an AI Edge in VBC: As value-based care models evolve and competition intensifies, healthcare leaders are seeking practical strategies to improve performance across risk, quality, and financial outcomes. Head over to Navina’s roundup of eight key insights from VBC leaders to learn how aligning AI-powered tools with organizational priorities and clinician needs can help secure a measurable competitive edge in value-based care.
- State of Payor Enrollment and Credentialing: Over half of provider orgs are losing revenue due to credentialing delays – with many missing out on over $1M annually. Medallion’s new report unpacks the forces quietly undermining operational and financial performance, and how leaders across the industry are addressing them. Head over to the full report to get insights tailored to your role and org type.
- The AI Hardware Built for Clinical Work: Phones were never meant to be propped on a desk for a 12-hour clinical day. Heidi Remote transcribes patient sessions offline, stores them securely on-device, and syncs to Heidi whenever you’re in range. Just clip on and get to work with the Heidi Remote.
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